Obamacare Insurance Exchange Websites: Tech Critique

State and federal websites' failure to work as advertised in first days of insurance availability can be blamed on software bottlenecks due to poor design.

Healthcare Robotics: Patently Incredible Inventions

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This is what happens when government decides it can provide an online shopping experience to rival Expedia. The online insurance exchanges mandated by the Affordable Care Act choked on a surge of traffic when they launched Tuesday to begin signing up consumers for policies that will take effect in January.

The widespread problems affected both the states that had set up their own online insurance websites and the federal government's Healthcare.gov site, which was available to the citizens of 36 other states. Although there had been advance warning of functional glitches and features that would not be ready for the initial launch, the sites largely failed at a much more basic level: They were incapable of fully meeting the demand from the public. The citizens flocking to the site because they are currently uninsured or paying too much for health insurance encountered websites that were slow, unresponsive, or just unreachable.

On its second day of operation, the Healthcare.gov site was still having problems. The website itself was available as a marketing website, just not consistently available as an application. At the first stage of the process, where users create an account and share the information necessary to match them with the plans they are eligible for, the signup form was only intermittently available. The most visible change from launch day to day two was a prettying up of the error message page, a sort of equivalent of the infamous Twitter "fail whale" shown when twitter.com is too busy -- saying, "We have a lot of visitors on the site right now. Please stay on this page. We're working to make the experience better, and we don't want you to lose your place in line. We'll send you to the login page as soon as we can. Thanks for your patience!"

On the plus side, boosters of the law and backers of President Obama tried to shrug off the poor Web experience as evidence of how much overwhelming demand there was from citizens for better access to affordable health insurance. As a general principle, Web software architects sometimes argue that it can be impossible to model how consumers will interact with a website until it's actually available to the public. So when the public relations folks for the exchanges complain of unexpectedly high traffic, should we cut them a little slack?

"The excuse that the load was unexpected -- in my opinion, that's not a good excuse," said Jyoti Bansal, founder and CEO of AppDynamics, an application performance management firm that counts Netflix among its customers. "They should have known better about that."

Planning and testing for a big website launch like this is certainly challenging, but it's not impossible, Bansal said. The right way to plan to have enough website capacity is to take your expected demand and at least double it, then create a series of test scripts that simulate that load, he said.

Healthcare.gov was still overloaded on day two.

Bansal suspects the real problem is that even though Obamacare proponents talked about wanting to provide a slick online consumer shopping experience, the government technologists (and even the consulting firms they hired) had too little experience with what that really means. Most federal and state organizations run largely informational websites or applications that serve a relatively small population of employees and contractors, he said. "Very few government organizations would have these sorts of very large scale, public, interactive, transactional Web apps -- it's a newer thing for them."

"Contractors do what they are incented to do..." becomes a catch-all excuse for outsourcer incompetence and failure to deliver. Professionals deliver in greater part because of their experience and merit. The initiative and energy that supposedly characterize private sector alchemy is not easily explained by being given appropriate incentives.

Not a "slog" or unfinished product-- Obamacare merely demonstrates what happens when powerful legislation meets power brokers. Those who followed the ACA through congress already know the external pressure applied to make sure the law met many different needs and expectations.

Every major legislative effort contains its own forgotten history of accommodations and adjustments that facilitated its passage.

Any post-event analysis should focus on why requirements validation was inadequate, if that turns out to be the case. Those with ideological agenda should withhold their judgment (uncharacteristically) until the facts are fully developed.

Free market advocates with an agenda to sell frequently pass along unexamined and negative, self-serving ideas about government. These "evangelists" ignore the fact it is government which created the foundations of the internet, made it work, and seeded the present day internet, handing their considerable achievement to the private sector.

Lost on such advocates is the fact former president G.W. Bush outsourced everything in the federal budget he could reach in his fundamentalist belief the private sector does it better, but instead caused a large net loss for the people of the United States. The record of his administration is jammed with inefficiencies and outright scandal from his awkward ideology-- anything but a demonstration project for the private sector.

As many Bush administration agencies quickly discovered, outsourcing to private profiteers to manage goods and services-- middle-men dedicated to their own gain, first and foremost-- is not the best prescription for efficiency. Those who need a textbook case need only consider the laggard and corrupt Bush-outsourced recovery from hurricane Katrina.

If Obamacare web services staff polish their act-- and there is every reason to believe they will-- the experience detailed by Mr. Carr reveals only the fallacy of uncritically outsourcing public business to the private sector, not the demerit for government he implies. Put another way, Carr's criticism of a "government" effort ends up in the lap of the private outsourcers who some now believe fumbled the project.

Contrary to Carr in his lead paragraph, healthcare.gov was not intended to rival Expedia, nor was the project done with the hubris he implies. From the beginning, healthcare.gov was a challenging undertaking with significant unknowns, even if the basic approach was established. Again, early criticism suggests CGI's own faulty assessment of the challenge.

Mr. Carr mentions some might consider offering the new project some slack, and then proceeds to his favorite sources to indicate no slack for the venture is merited. Unfortunately, this renders only a very jaundiced viewpoint resembling industrial-grade pamphleteering.

Carr must be excused, however-- he works for a publication which filters every opinion for compliance with its own free-market mythology. As this article makes clear, such a lingering, Bush-era mindset considerably lessens the value of its own editorial product.

Contractors do what they are incented to do. Were the contractors incented to make load testing a key part of their project? Companies like Akamai and Soasta have deep expertise in this area; Do the contractors used here have that type of alumni?

The notion that these sites should've bought a whole lot more processing capacity to avoid any bottlenecks doesn't ring true to me, from a cost-benefit analysis of using taxpayer money. Is it really worth such over-provisioning data center capacity to avoid all delays and failures in these early, spikey days of visits? David's comparison to Twitter's Fail Whale is a good one, these things do happen in the private sector as well, where companies make ruthless "is it worth it?" tech buying decisions.

It appears that the site was built by the private sector although most of the article seems to suggest that it was federal employees that did the development. I read every excuse that an incompetent consultant gives for project failure.

THe contractors didn't have complete requirements

The site buckled under the unanticipated load

The site design was poor because of the requirements.

A competent development team would have vetted the requirements, tested the system for worst cases conditions, and started with a web design that would have the load.

Why is the finger pointed at the Obama administration and not the contractors? They are not healthcare web site experts and that is why they hired someone else. Are you going to do two pages on CGI's failures?

Considering all of the highly visible failures in the past severalyears, I am somewhat surprised that the Federal Health Website continues todemonstrate sluggish performance. With the visibility surrounding thismilestone in the Affordable Care Act, I would have expected that thoseresponsible had anticipated this volume and prepared to ensure the system wouldbe able to accommodate the volume of transactions.

This assurance starts in the requirements phase of the systemdesign and build. Contained in the requirements specification is theanticipated/expected usage levels. When all of the requirements are met, we geta high quality system that meets performance expectations. I have towonder if these requirements were properly defined, communicated, andvalidated. The current level of performance indicates a failure in that process.

LetG«÷s remember that the definition of a systemG«÷s quality iscontained in the requirements. The better they are defined, managed, andvalidated, the higher the quality of the system delivered. I suspect thatmost who have attempted to use the system would claim that the quality islowG«™at least in the registration phase.

Ensuring that the system performance requirements arecorrect and are properly validated is where I recommend that the HHS focus itsenergy in order to make it easier for people to register for thenew healthcare program.

Healthcare data is nothing new, but yet, why do healthcare improvements from quantifiable data seem almost rare today? Healthcare administrators have a wealth of data accessible to them but aren't sure how much of that data is usable or even correct.